1
|
Mitchell AK, Ehrenkranz R, Franzen S, Han SH, Shakur M, McGowan M, Massett HA. Analysis of eligibility criteria in Alzheimer's and related dementias clinical trials. Sci Rep 2024; 14:15036. [PMID: 38951633 PMCID: PMC11217383 DOI: 10.1038/s41598-024-65767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
Overly restrictive clinical trial eligibility criteria can reduce generalizability, slow enrollment, and disproportionately exclude historically underrepresented populations. The eligibility criteria for 196 Alzheimer's Disease and Related Dementias (AD/ADRD) trials funded by the National Institute on Aging were analyzed to identify common criteria and their potential to disproportionately exclude participants by race/ethnicity. The trials were categorized by type (48 Phase I/II pharmacological, 7 Phase III/IV pharmacological, 128 non-pharmacological, 7 diagnostic, and 6 neuropsychiatric) and target population (51 AD/ADRD, 58 Mild Cognitive Impairment, 25 at-risk, and 62 cognitively normal). Eligibility criteria were coded into the following categories: Medical, Neurologic, Psychiatric, and Procedural. A literature search was conducted to describe the prevalence of disparities for eligibility criteria for African Americans/Black (AA/B), Hispanic/Latino (H/L), American Indian/Alaska Native (AI/AN) and Native Hawaiian/Pacific Islander (NH/PI) populations. The trials had a median of 15 criteria. The most frequent criterion were age cutoffs (87% of trials), specified neurologic (65%), and psychiatric disorders (61%). Underrepresented groups could be disproportionately excluded by 16 eligibility categories; 42% of trials specified English-speakers only in their criteria. Most trials (82%) contain poorly operationalized criteria (i.e., criteria not well defined that can have multiple interpretations/means of implementation) and criteria that may reduce racial/ethnic enrollment diversity.
Collapse
Affiliation(s)
| | | | - Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, 20852, USA
| | - Mujaahida Shakur
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA
| | - Melissa McGowan
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA
| | - Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA.
| |
Collapse
|
2
|
Agénor M, Noh M, Eiduson R, LeBlanc M, Line EC, Goldman RE, Potter J, Austin SB. Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States. BMC Womens Health 2024; 24:362. [PMID: 38907205 PMCID: PMC11191319 DOI: 10.1186/s12905-024-03151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. METHODS We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. RESULTS Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. CONCLUSIONS Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.
Collapse
Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Merrily LeBlanc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Sociology, Northeastern University, Boston, MA, USA
| | - Emmett C Line
- Teachers College, Columbia University, New York, NY, USA
| | - Roberta E Goldman
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Algu K, Wales J, Anderson M, Omilabu M, Briggs T, Kurahashi AM. Naming racism as a root cause of inequities in palliative care research: a scoping review. BMC Palliat Care 2024; 23:143. [PMID: 38858646 PMCID: PMC11163751 DOI: 10.1186/s12904-024-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Racial and ethnic inequities in palliative care are well-established. The way researchers design and interpret studies investigating race- and ethnicity-based disparities has future implications on the interventions aimed to reduce these inequities. If racism is not discussed when contextualizing findings, it is less likely to be addressed and inequities will persist. OBJECTIVE To summarize the characteristics of 12 years of academic literature that investigates race- or ethnicity-based disparities in palliative care access, outcomes and experiences, and determine the extent to which racism is discussed when interpreting findings. METHODS Following Arksey & O'Malley's methodology for scoping reviews, we searched bibliographic databases for primary, peer reviewed studies globally, in all languages, that collected race or ethnicity variables in a palliative care context (January 1, 2011 to October 17, 2023). We recorded study characteristics and categorized citations based on their research focus-whether race or ethnicity were examined as a major focus (analyzed as a primary independent variable or population of interest) or minor focus (analyzed as a secondary variable) of the research purpose, and the interpretation of findings-whether authors directly or indirectly discussed racism when contextualizing the study results. RESULTS We identified 3000 citations and included 181 in our review. Of these, most were from the United States (88.95%) and examined race or ethnicity as a major focus (71.27%). When interpreting findings, authors directly named racism in 7.18% of publications. They were more likely to use words closely associated with racism (20.44%) or describe systemic or individual factors (41.44%). Racism was directly named in 33.33% of articles published since 2021 versus 3.92% in the 10 years prior, suggesting it is becoming more common. CONCLUSION While the focus on race and ethnicity in palliative care research is increasing, there is room for improvement when acknowledging systemic factors - including racism - during data analysis. Researchers must be purposeful when investigating race and ethnicity, and identify how racism shapes palliative care access, outcomes and experiences of racially and ethnically minoritized patients.
Collapse
Affiliation(s)
- Kavita Algu
- Temmy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T3L9, Canada.
| | - Joshua Wales
- Temmy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T3L9, Canada
| | - Michael Anderson
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Mariam Omilabu
- Temmy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T3L9, Canada
| | - Thandi Briggs
- Home and Community Care Support Services Toronto Central, 250 Dundas St. W, Toronto, ON, M5T 2Z5, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T3L9, Canada
| |
Collapse
|
4
|
Albandar JM. Disparities and social determinants of periodontal diseases. Periodontol 2000 2024. [PMID: 38217495 DOI: 10.1111/prd.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/08/2023] [Indexed: 01/15/2024]
Abstract
Periodontal diseases are highly prevalent in populations worldwide and are a major global public health problem, with major negative impacts on individuals and communities. This study investigates evidence of disparities in periodontal diseases by age groups, gender, and socioeconomic factors. There is ample evidence that these diseases disproportionally affect poorer and marginalized groups and are closely associated with certain demographics and socioeconomic status. Disparities in periodontal health are associated with social inequalities, which in turn are caused by old age, gender inequality, income and education gaps, access to health care, social class, and other factors. In health care, these factors may result in some individuals receiving better and more professional care compared to others. This study also reviews the potential causes of these disparities and the means to bridge the gap in disease prevalence. Identifying and implementing effective strategies to eliminate inequities among minorities and marginalized groups in oral health status and dental care should be prioritized in populations globally.
Collapse
Affiliation(s)
- Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Thomas JJ, Johnson S, Holden KB, Hutchins S. Treating black patients as "knowers". J Natl Med Assoc 2023; 115:584-588. [PMID: 37968177 DOI: 10.1016/j.jnma.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/25/2023] [Accepted: 09/30/2023] [Indexed: 11/17/2023]
Abstract
Recent trends in healthcare policy from high-volume service models to "high-value" delivery systems have refocused the need for patient-centered approaches to quality care. However, benchmarks of how to define and evaluate successful patient-centeredness have not been sufficiently established. Such ill-defined evaluation criteria can further exacerbate systemic inequities in maximum quality health care delivery, especially based on the intersectional diversity of various patient populations. In this context, applying a phenomenology of medicine framework or perspective-driven analysis is useful in defining cross-cultural patient-centeredness. This reframing from a naturalistic or objective/biological viewpoint to a phenomenological viewpoint may aid in placing greater epistemic or knowledge authority in the hands of vulnerable and/or marginalized patients- allowing these patients to become key "knowers" in the clinical interaction. Moreover, treating Black patients as "knowers" emphasizes the prioritization of patient values at the core of providing valuable healthcare. Such an academic, policy, and clinical approach to medicine agrees with well-established principles of medical ethics. In addition, the framework of a phenomenology of medicine can better facilitate physician-patient communication and interaction by delineating often muddled hermeneutics.
Collapse
Affiliation(s)
- Justin J Thomas
- School of Medicine, Morehouse, 720 Westview Dr SW, NCPC, Room 324-B, Atlanta, GA, USA.
| | - Shaneeta Johnson
- School of Medicine, Morehouse, 720 Westview Dr SW, NCPC, Room 324-B, Atlanta, GA, USA
| | - Kisha B Holden
- School of Medicine, Morehouse, 720 Westview Dr SW, NCPC, Room 324-B, Atlanta, GA, USA
| | - Sonja Hutchins
- School of Medicine, Morehouse, 720 Westview Dr SW, NCPC, Room 324-B, Atlanta, GA, USA
| |
Collapse
|
6
|
Adsul P, Austin JD, Chebli P, Dias EM, Hirschey R, Ravi P, Seaman AT, Vogel R. From study plans to capacity building: a journey towards health equity in cancer survivorship. Cancer Causes Control 2023; 34:7-13. [PMID: 37851185 PMCID: PMC10689513 DOI: 10.1007/s10552-023-01808-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
This article highlights the importance of pausing and reflecting on one's motivation, capacity, and positionality when engaging in health equity research and encourages researchers to engage in critical self-reflection and contribute to the ongoing dialogue on the ethical conduct of health equity-focused cancer research. In response to the urgent need to address health disparities and improve health equity in cancer survivorship care, the Cancer Prevention and Control Research Network (CPCRN) Survivorship workgroup discussed developing a study focused on understanding how racism impacts patient engagement in cancer survivorship care. However, during the study's development, the workgroup recognized limitations in research team composition and infrastructure. The workgroup engaged in critical self-reflections, individually and collectively, leading to the halting of the research study. Consequently, they redirected their efforts towards strengthening the necessary infrastructure for conducting such research, including diverse investigator representation and equitable partnerships with cancer survivors. The description of this process, along with suggestions for reflection, may be helpful and informative to other researchers and research networks seeking to center marginalized voices and work in partnership to address healthcare and health equity.
Collapse
Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Perla Chebli
- Department of Population Health, Grossman School of Medicine, NYU Langone, New York, NY, USA
| | - Emanuelle M Dias
- Department of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Priyanka Ravi
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Aaron T Seaman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Rosi Vogel
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
7
|
Chapman C, Jayasekera J, Dash C, Sheppard V, Mandelblatt J. A health equity framework to support the next generation of cancer population simulation models. J Natl Cancer Inst Monogr 2023; 2023:255-264. [PMID: 37947339 PMCID: PMC10846912 DOI: 10.1093/jncimonographs/lgad017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/03/2023] [Accepted: 06/22/2023] [Indexed: 11/12/2023] Open
Abstract
Over the past 2 decades, population simulation modeling has evolved as an effective public health tool for surveillance of cancer trends and estimation of the impact of screening and treatment strategies on incidence and mortality, including documentation of persistent cancer inequities. The goal of this research was to provide a framework to support the next generation of cancer population simulation models to identify leverage points in the cancer control continuum to accelerate achievement of equity in cancer care for minoritized populations. In our framework, systemic racism is conceptualized as the root cause of inequity and an upstream influence acting on subsequent downstream events, which ultimately exert physiological effects on cancer incidence and mortality and competing comorbidities. To date, most simulation models investigating racial inequity have used individual-level race variables. Individual-level race is a proxy for exposure to systemic racism, not a biological construct. However, single-level race variables are suboptimal proxies for the multilevel systems, policies, and practices that perpetuate inequity. We recommend that future models designed to capture relationships between systemic racism and cancer outcomes replace or extend single-level race variables with multilevel measures that capture structural, interpersonal, and internalized racism. Models should investigate actionable levers, such as changes in health care, education, and economic structures and policies to increase equity and reductions in health-care-based interpersonal racism. This integrated approach could support novel research approaches, make explicit the effects of different structures and policies, highlight data gaps in interactions between model components mirroring how factors act in the real world, inform how we collect data to model cancer equity, and generate results that could inform policy.
Collapse
Affiliation(s)
- Christina Chapman
- Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston VA, Houston, TX, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, National Institute on Minority Health and Health Disparities, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research and Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Vanessa Sheppard
- Department of Health Behavior and Policy and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeanne Mandelblatt
- Departments of Oncology and Medicine, Georgetown University Medical Center, Cancer Prevention and Control Program at Georgetown Lombardi Comprehensive Cancer Center and the Georgetown Lombardi Institute for Cancer and Aging Research, Washington, DC, USA
| |
Collapse
|
8
|
Vajravelu ME, Okah E, Bensignor M, Karbeah J. A Call to Replace Race- and Ethnicity-Based Screening with Health-Related Social Needs Evaluation When Assessing Risk of Type 2 Diabetes in Youth. J Adolesc Health 2023; 73:620-621. [PMID: 37542507 PMCID: PMC10926327 DOI: 10.1016/j.jadohealth.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 08/07/2023]
Affiliation(s)
- Mary Ellen Vajravelu
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Ebiere Okah
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Megan Bensignor
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Division of Pediatric Endocrinology and Diabetes, University of Minnesota Medical School, Minneapolis, Minnesota
| | - J'Mag Karbeah
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota; Center for Antiracism Research for Health Equity, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
9
|
Vasan RS, Rao S, van den Heuvel E. Race as a Component of Cardiovascular Disease Risk Prediction Algorithms. Curr Cardiol Rep 2023; 25:1131-1138. [PMID: 37581773 DOI: 10.1007/s11886-023-01938-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE OF REVIEW Several prediction algorithms include race as a component to account for race-associated variations in disease frequencies. This practice has been questioned recently because of the risk of perpetuating race as a biological construct and diverting attention away from the social determinants of health (SDoH) for which race might be a proxy. We evaluated the appropriateness of including race in cardiovascular disease (CVD) prediction algorithms, notably the pooled cohort equations (PCE). RECENT FINDINGS In a recent investigation, we reported substantial and biologically implausible differences in absolute CVD risk estimates upon using PCE for predicting CVD risk in Black and White persons with identical risk factor profiles, which might result in differential treatment decisions based solely on their race. We recommend the development of raceless CVD risk prediction algorithms that obviate race-associated risk misestimation and racializing treatment practices, and instead incorporate measures of SDoH that mediate race-associated risk differences.
Collapse
Affiliation(s)
- Ramachandran S Vasan
- University of Texas School of Public Health and University of Texas Health Sciences Center, 8403 Floyd Curl Drive, Mail Code 7992, San Antonio, TX 78229, USA.
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Shreya Rao
- University of Texas School of Public Health and University of Texas Health Sciences Center, 8403 Floyd Curl Drive, Mail Code 7992, San Antonio, TX 78229, USA
| | - Edwin van den Heuvel
- Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, the Netherlands
| |
Collapse
|
10
|
MICHAELS ELIK, LAM‐HINE TRACY, NGUYEN THUT, GEE GILBERTC, ALLEN AMANIM. The Water Surrounding the Iceberg: Cultural Racism and Health Inequities. Milbank Q 2023; 101:768-814. [PMID: 37435779 PMCID: PMC10509530 DOI: 10.1111/1468-0009.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 07/13/2023] Open
Abstract
Policy Points Cultural racism-or the widespread values that privilege and protect Whiteness and White social and economic power-permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities. Overt forms of racism, such as racial hate crimes, represent only the "tip of the iceberg," whereas structural and institutional racism represent its base. This paper advances cultural racism as the "water surrounding the iceberg," allowing it to float while obscuring its base. Considering the fundamental role of cultural racism is needed to advance health equity. CONTEXT Cultural racism is a pervasive social toxin that surrounds all other dimensions of racism to produce and maintain racial health inequities. Yet, cultural racism has received relatively little attention in the public health literature. The purpose of this paper is to 1) provide public health researchers and policymakers with a clearer understanding of what cultural racism is, 2) provide an understanding of how it operates in conjunction with the other dimensions of racism to produce health inequities, and 3) offer directions for future research and interventions on cultural racism. METHODS We conducted a nonsystematic, multidisciplinary review of theory and empirical evidence that conceptualizes, measures, and documents the consequences of cultural racism for social and health inequities. FINDINGS Cultural racism can be defined as a culture of White supremacy, which values, protects, and normalizes Whiteness and White social and economic power. This ideological system operates at the level of our shared social consciousness and is expressed in the language, symbols, and media representations of dominant society. Cultural racism surrounds and bolsters structural, institutional, personally mediated, and internalized racism, undermining health through material, cognitive/affective, biologic, and behavioral mechanisms across the life course. CONCLUSIONS More time, research, and funding is needed to advance measurement, elucidate mechanisms, and develop evidence-based policy interventions to reduce cultural racism and promote health equity.
Collapse
Affiliation(s)
- ELI K. MICHAELS
- Division of Epidemiology, School of Public HealthUniversity of California
| | - TRACY LAM‐HINE
- Division of Epidemiology & Population HealthStanford University School of Medicine
| | | | - GILBERT C. GEE
- Jonathan and Karin Fielding School of Public HealthUniversity of California
| | - AMANI M. ALLEN
- Division of Epidemiology, School of Public HealthUniversity of California
- Division of Community Health Sciences, School of Public HealthUniversity of California
| |
Collapse
|
11
|
Wispelwey B, Tanous O, Asi Y, Hammoudeh W, Mills D. Because its power remains naturalized: introducing the settler colonial determinants of health. Front Public Health 2023; 11:1137428. [PMID: 37533522 PMCID: PMC10393129 DOI: 10.3389/fpubh.2023.1137428] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/23/2023] [Indexed: 08/04/2023] Open
Abstract
Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious to comprehensive and convincing explication, let alone remediation. Settler colonial studies, a fast-growing multidisciplinary and interdisciplinary field, is a promising candidate to rectify this impasse. Settler colonialism's relationship to health inequity is at once obvious and incompletely described, a paradox arising from epistemic coloniality and perceived analytic challenges that we address here in three parts. First, in considering settler colonialism an enduring structure rather than a past event, and by wedding this fundamental insight to the ascendant structural paradigm for understanding health inequities, a picture emerges in which this system of power serves as a foundational and ongoing configuration determining social and political mechanisms that impose on human health. Second, because modern racialization has served to solidify and maintain the hierarchies of colonial relations, settler colonialism adds explanatory power to racism's health impacts and potential amelioration by historicizing this process for differentially racialized groups. Finally, advances in structural racism methodologies and the work of a few visionary scholars have already begun to elucidate the possibilities for a body of literature linking settler colonialism and health, illuminating future research opportunities and pathways toward the decolonization required for health equity.
Collapse
Affiliation(s)
- Bram Wispelwey
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, MA, United States
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
| | - Osama Tanous
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
| | - Yara Asi
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- School of Global Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, FL, United States
| | - Weeam Hammoudeh
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - David Mills
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
12
|
Bao Y, Xu Y, Li Z, Wu Q. Racial and ethnic difference in the risk of fractures in the United States: a systematic review and meta-analysis. Sci Rep 2023; 13:9481. [PMID: 37301857 PMCID: PMC10257681 DOI: 10.1038/s41598-023-32776-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/02/2023] [Indexed: 06/12/2023] Open
Abstract
This systematic review and meta-analysis examined the association between race and ethnicity and fracture risk in the United States. We identified relevant studies by searching PubMed and EMBASE for studies published from the databases' inception date to December 23, 2022. Only observational studies conducted in the US population that reported the effect size of racial-ethnic minority groups versus white people were included. Two investigators independently conducted literature searches, study selection, risk of bias assessment, and data abstraction; discrepancies were resolved by consensus or consultation of a third investigator. Twenty-five studies met the inclusion criteria, and the random-effects model was used to calculate the pooled effect size due to heterogeneity between the studies. Using white people as the reference group, we found that people of other races and ethnic groups had a significantly lower fracture risk. In Black people, the pooled relative risk (RR) was 0.46 (95% confidence interval (CI), 0.43-0.48, p < 0.0001). In Hispanics, the pooled RR was 0.66 (95% CI, 0.55-0.79, p < 0.0001). In Asian Americans, the pooled RR was 0.55 (95% CI, 0.45-0.66, p < 0.0001). In American Indians, the pooled RR was 0.80 (95% CI, 0.41-1.58, p = 0.3436). Subgroup analysis by sex in Black people revealed the strength of association was greater in men (RR = 0.57, 95% CI = 0.51-0.63, p < 0.0001) than in women (RR = 0.43, 95% CI = 0.39-0.47, p < 0.0001). Our findings suggest that people of other races and ethnic groups have a lower fracture risk than white people.
Collapse
Affiliation(s)
- Yueyang Bao
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
- Department of Biology, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Yingke Xu
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Zhuowei Li
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
| | - Qing Wu
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
13
|
Russell R, Fleming-Hall E, Wilson-Delfosse A, Ashby K. An Institutional Evaluation of Race and Ethnic Diversity in Pre-clerkship Lectures. MEDICAL SCIENCE EDUCATOR 2023; 33:645-651. [PMID: 37501795 PMCID: PMC10368599 DOI: 10.1007/s40670-023-01789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 07/29/2023]
Abstract
The goal of this project was to assess the current state of racial and ethnic presentation in medical pedagogy using the pre-clerkship curriculum at Case Western Reserve University School of Medicine (CWRU SOM). We systematically reviewed 20,630 slides across the basic sciences curriculum from 2020 to 2022 for references to race, ethnicity, or photos of people of color. Results showed that race and ethnicity are overwhelmingly used as biological constructs and references lack appropriate historical context. In addition, this project constructed learning objectives that provide suggestions to shift medical discourse on race and ethnicity from contemplation to a state of solution.
Collapse
Affiliation(s)
- Rebekah Russell
- Case Western Reserve University School of Medicine, Cleveland, USA
| | | | | | - Karen Ashby
- University Hospitals Cleveland, Cleveland, OH USA
| |
Collapse
|
14
|
Ray K, Fletcher FE, Martschenko DO, James JE. Black Bioethics in the Age of Black Lives Matter. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:251-267. [PMID: 36752936 PMCID: PMC9905759 DOI: 10.1007/s10912-023-09783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Keisha Ray
- McGovern Medical School, University of Texas Health Science Center, Jesse Jones Library 450, Houston, TX USA
| | - Faith E. Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX USA
| | - Daphne O. Martschenko
- Stanford Center for Biomedical Ethics and Department of Pediatrics, Stanford University, Stanford, CA USA
| | - Jennifer E. James
- Department of Social & Behavioral Sciences, and UCSF Bioethics, University of California, San Francisco, CA USA
| |
Collapse
|
15
|
Liao SY, Carbonell V. Materialized Oppression in Medical Tools and Technologies. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:9-23. [PMID: 35262465 DOI: 10.1080/15265161.2022.2044543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems.
Collapse
|
16
|
Khazanchi R, Soled DR, Yearby R. Racism-Conscious Praxis: A Framework to Materialize Anti-Oppression in Medicine, Public Health, and Health Policy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:31-34. [PMID: 37011342 DOI: 10.1080/15265161.2023.2186521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Rohan Khazanchi
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham & Women's Hospital, Boston Children's Hospital, and Boston Medical Center
- Harvard Medical School
| | - Derek R Soled
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham & Women's Hospital, Boston Children's Hospital, and Boston Medical Center
- Harvard Medical School
| | - Ruqaiijah Yearby
- Moritz College of Law, The Ohio State University
- Kirwan Institute for the Study of Race and Ethnicity, The Ohio State University
- The Institute for Healing Justice & Equity
| |
Collapse
|
17
|
Owusu-Ansah S, Tripp R, N Weisberg S, P Mercer M, Whitten-Chung K. Essential Principles to Create an Equitable, Inclusive, and Diverse EMS Workforce and Work Environment: A Position Statement and Resource Document. PREHOSP EMERG CARE 2023:1-5. [PMID: 36867425 DOI: 10.1080/10903127.2023.2187103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
POSITION STATEMENTEmergency medical services (EMS), similar to all aspects of health care systems, can play a vital role in examining and reducing health disparities through educational, operational, and quality improvement interventions. Public health statistics and existing research highlight that patients of certain socioeconomic status, gender identity, sexual orientation, and race/ethnicity are disproportionately affected with respect to morbidity and mortality for acute medical conditions and multiple disease processes, leading to health disparities and inequities. With regard to care delivery by EMS, research demonstrates that the current attributes of EMS systems may further contribute to these inequities, such as documented health disparities existing in EMS patient care management, and access along with EMS workforce composition not being representative of the communities served influencing implicit bias. EMS clinicians need to understand the definitions, historical context, and circumstances surrounding health disparities, health care inequities, and social determinants of health in order to reduce health care disparities and promote care equity. This position statement focuses on systemic racism and health disparities in EMS patient care and systems by providing multifaceted next steps and priorities to address these disparities and workforce development. NAEMSP believes that EMS systems should:Adopt a multifactorial approach to workforce diversity implemented at all levels within EMS agencies.Hire more diverse workforce by intentionally recruiting from marginalized communitiesIncrease EMS career pathway and mentorship programs within underrepresented minorities (URM) communities and URM-predominant schools starting at a young age to promote EMS as an achievable profession.Examine policies that promote systemic racism and revise policies, procedures, and rules to promote a diverse, inclusive, and equitable environment.Involve EMS clinicians in community engagement and outreach activities to promote health literacy, trustworthiness, and education.Require EMS advisory boards whose composition reflects the communities they serve and regularly audit membership to ensure inclusion.Increase knowledge and self-awareness of implicit/unconscious bias and acts of microaggression through established educational and training programs (i.e., anti- racism, upstander, and allyship) such that individuals recognize and mitigate their own biases and can act as allies.Redesign structure, content, and classroom materials within EMS clinician training programs to enhance cultural sensitivity, humility, and competency and to meet career development, career planning, and mentoring needs, particularly of URM EMS clinicians and trainees.Discuss cultural views that affect health care and medical treatment and the effects of social determinants of health on care access and outcomes during all aspects of training.Design research and quality improvement initiatives related to health disparities in EMS that are focused on racial/ethnic and gender inequities and include URM community leaders as essential stakeholders involved in all stages of research development and implementation.
Collapse
Affiliation(s)
- Sylvia Owusu-Ansah
- Division of Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rickquel Tripp
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Stacy N Weisberg
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Mary P Mercer
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Kimberly Whitten-Chung
- Department of EMS/Medical Sciences, Pikes Peak State College, Colorado Springs, Colorado
| | | |
Collapse
|
18
|
Reid MR, Danguecan AN, Colindres I, Witherspoon D, Rubinstein TB, Drenkard C, Knight AM, Cunningham NR. An ecological approach to understanding and addressing health inequities of systemic lupus erythematosus. Lupus 2023; 32:612-624. [PMID: 36922154 DOI: 10.1177/09612033231164637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Systemic Lupus Erythematosus (SLE) is a complex chronic autoimmune disease disproportionally afflicting women and, in particular, American Indian/Alaska Native, Black, and Hispanic women. These groups of women have significantly worse SLE-related health outcomes which are partially attributable to their exposure to marginalizing and interconnecting social issues like racism, sexism, economic inequality, and more. Although these groups of women have higher rates of SLE and though it is well known that they are at risk of exposure to marginalizing social phenomena, relatively little SLE literature explicitly links and addresses the relationship between marginalizing social issues and poor SLE-health outcomes among these women. Therefore, we developed a community-engaged partnership with two childhood-SLE diagnosed women of color to identify their perspectives on which systemic issues impacted on their SLE health-related outcomes. Afterward, we used Cochrane guidelines to conduct a rapid review associated with these identified issues and original SLE research. Then, we adapted an ecological model to illustrate the connection between systems issues and SLE health outcomes. Finally, we provided recommendations for ways to research and clinically mitigate SLE health inequities.
Collapse
Affiliation(s)
- Mallet R Reid
- Department of Family Medicine, College of Human Medicine, 3078Michigan State University, Grand Rapids, MI, USA
| | - Ashley N Danguecan
- Division of Rheumatology, 7979The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Tamar B Rubinstein
- Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY, USA
| | | | - Andrea M Knight
- Division of Rheumatology, 7979The Hospital for Sick Children, Toronto, ON, Canada
| | - Natoshia R Cunningham
- Department of Family Medicine, College of Human Medicine, 3078Michigan State University, Grand Rapids, MI, USA
| |
Collapse
|
19
|
Godde K, Gough Courtney M, Roberts J. Health Insurance Coverage as a Social Determinant of Osteoporosis Diagnosis in a Population-Based Cohort Study of Older American Adults. J Appl Gerontol 2023; 42:302-312. [PMID: 36222070 PMCID: PMC9841821 DOI: 10.1177/07334648221132792] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Social determinants of health theoretical frameworks identify health insurance coverage as a determinant of older adults' osteoporosis diagnoses, which results in health inequities. In this research, we used the longitudinal Health and Retirement Study dataset of older United States adults, sampled biennially from 2012 to 2016. Logistic regressions estimated odds of osteoporosis diagnosis with and without a bone scan and/or hip fracture, holding insurance type, and health and demographic factors constant. Results were validated using the National Health and Nutrition Examination Survey. Probable underdiagnosing is present in older adults identifying as Black/African American and as males without a bone scan, regardless of fracture status, potentially as products of structural racism and sexism. Models including a bone scan show a reduction in disparities. These findings suggest having a bone scan is still crucial for addressing health inequities in older adults, and remedying barriers to accessing a scan is paramount.
Collapse
Affiliation(s)
- Kanya Godde
- Department of Sociology/Anthropology, University of La Verne, CA, USA,Kanya Godde, Department of Sociology/Anthropology, University of La Verne, 1950 Third St, La Verne, CA 91750-4401, USA.
| | | | - Josephine Roberts
- Department of Sociology/Anthropology, University of La Verne, CA, USA
| |
Collapse
|
20
|
Derricks V, Johnson IR, Pietri ES. Black (patients') lives matter: Exploring the role of identity-safety cues in healthcare settings among Black Americans. J Health Psychol 2023; 28:30-47. [PMID: 35570659 DOI: 10.1177/13591053221090850] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Two online experiments investigated whether hypothetical physicians' use of an identity-safety cue acknowledging systemic injustice (a Black Lives Matter pin) improves Black Americans' evaluations of the physician and feelings of identity-safety. Across studies, findings showed that when a White physician employed the identity-safety cue, Black Americans reported stronger perceptions of physician allyship and increased identity-safety (e.g. trust). As predicted, use of the identity-safety cue produced smaller or non-significant effects when employed by a Black physician. These benefits emerged regardless of physicians' perceived motivation for employing the cue (e.g. whether the physician was personally motivated to employ the cue or his medical practice encouraged use of the cue; Study 2). Furthermore, analyses revealed that exposure to the identity-safety cue promoted a greater sense of identity-safety for Black Americans due to increased perceptions that the physician is an ally for Black individuals. Implications of identity-safety cues for racially discordant medical interactions are discussed.
Collapse
Affiliation(s)
- Veronica Derricks
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
| | - India R Johnson
- Department of Psychology, Butler University, Indianapolis, IN, USA
| | - Evava S Pietri
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| |
Collapse
|
21
|
Understanding Racism in Anesthesia Care. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
22
|
O’Driscoll G, Bawden D. Health information equity: Rebalancing healthcare collections for racial diversity in UK public service contexts. EDUCATION FOR INFORMATION 2022. [DOI: 10.3233/efi-220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
COVID-19 illustrated health disparities experienced by racially minoritised people, with heightened risks faced by Black and South Asian communities lending the issue transparency and urgency. Despite efforts to decolonise medical education, deficits in racial representation in research and resources remain. This study investigates the potential and imperatives for healthcare information services to contribute to health equity through their collections. The literature analysis explores collection management, decolonisation, social justice in librarianship, and Critical Race Theory (CRT) as a framework for change in information contexts. A survey of UK National Health Service (NHS) librarians provides a snapshot of awareness of health information inequity. Semi-structured interviews explore information professionals’ experiences of anti-racism in the system. The findings indicate strong engagement with the need for equitable resources but highlight some barriers to success. Opportunities identified include potential for addressing systemic racism in collection policy, capability of information services to influence, or engage in, authorship and publishing to address gaps, and the need for race-based data standards in healthcare. Synthesis of the findings through a framework of CRT tenets illustrates the relevance and utility of CRT as a tool for pursuit of equity in information practice, scholarship, and education.
Collapse
|
23
|
Cerdeña JP, Asabor EN, Plaisime MV, Hardeman RR. Race-based medicine in the point-of-care clinical resource UpToDate: A systematic content analysis. EClinicalMedicine 2022; 52:101581. [PMID: 35923427 PMCID: PMC9340501 DOI: 10.1016/j.eclinm.2022.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Race-based practices in medical education and clinical care may exacerbate health inequities. Misguided use of race in popular point-of-care clinical decision-making tools like UpToDate® may promote harmful practices of race-based medicine. This article investigates the nature of mentions of Black/African American race in UpToDate®. METHODS We conducted a systematic content analysis of UpToDate® articles mentioning Black or African American race to assess for biological interpretations of racial categories. Following a simple text search for the terms "Black" and "African American" in UpToDate® on January 24 and March 19, 2020, respectively, removal of duplicates yielded an analytical sample of 208 documents. We adopted a deductive coding approach and systematically applied 16 a priori codes to all documents, refining the codebook to achieve a final inter-rater reliability of 0.91. We then developed these codes into two themes: (1) biologization of race and (2) racialized research and practice. FINDINGS Biologization of race occurred nearly universally across all documents (93.3%), with discussions of inherent physiological differences between racial groups and presentation of epidemiologic disparities without context emerging most frequently. Sixty-eight documents (32.7%) included codes related to racialized biomedical research and clinical practice, including references to racialized patterns of behavior and cultural practices, insufficient data on Black populations, research limiting study to a specific racial group, and race-based clinical practices guidelines. INTERPRETATION Our findings suggest that UpToDate® articles often inappropriately link Black race to genetics or clinical phenotype-without considering socio-structural variables or the health effects of structural racism-thus perpetuating a false narrative that race is inherently biological. UpToDate® articles may also promote unequal treatment by recommending race-based clinical practices. Such racial essentialism risks exacerbating racialized health inequities. FUNDING The study is supported by the Health Policy Research Scholars Program, Robert Wood Johnson Foundation, Medical Scientist Training Program, National Institutes of Health, the National Science Foundation, the JPB Foundation, the Minnesota Population, the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD), and the Center for Antiracism Research for Health Equity at the University of Minnesota.
Collapse
Affiliation(s)
- Jessica P. Cerdeña
- Yale School of Medicine, New Haven, CT, USA
- Department of Anthropology, University of Connecticut, Storrs, CT, USA
- Corresponding author at: Yale School of Medicine MD/PhD Program, 367 Cedar Street, New Haven, CT 06510.
| | - Emmanuella Ngozi Asabor
- Yale School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Marie V. Plaisime
- FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Affiliate Postdoctoral Research Fellow, Penn Program on Race, Science & Society Center for Africana Studies (PRSS), University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R. Hardeman
- Center for Antiracism Research for Health Equity, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
24
|
Heiden BT, Eaton DB, Chang SH, Yan Y, Baumann AA, Schoen MW, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Racial Disparities in the Surgical Treatment of Clinical Stage I Non-Small Cell Lung Cancer Among Veterans. Chest 2022; 162:920-929. [PMID: 35405111 PMCID: PMC9562435 DOI: 10.1016/j.chest.2022.03.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prior studies in the civilian population have reported racial disparities in lung cancer outcomes following surgical treatment, including inferior quality of care and worse survival. It is unclear if racial disparities exist in the Veterans Health Administration (VHA), the largest integrated health care system in the United States. RESEARCH QUESTION Do racial disparities affect early-stage non-small cell lung cancer (NSCLC) outcomes following surgical treatment within the VHA? STUDY DESIGN AND METHODS This retrospective cohort study was conducted in veterans with clinical stage I NSCLC undergoing surgical treatment in the VHA system. Demographic characteristics, access to care, surgical quality measures, and short- and long-term oncologic outcomes between White and Black veterans were evaluated. RESULTS From 2006 to 2016, a total of 18,800 veterans with clinical stage I NSCLC were included. The rates of definitive surgical treatment were similar between Black (57.3%) and White (58.1%) veterans (P = .42). The final study cohort included 9,842 patients receiving surgical treatment, of whom 8,356 (84.9%) were White and 1,486 (15.1%) were Black. Black patients were younger and more likely to smoke, although comorbidities were similar between the two groups. Black patients were somewhat less likely to receive adequate lymph node sampling (30.6% vs 33.3%; P = .050); however, other access-to-care metrics and surgical quality measures, including rates of anatomic lobectomy (71.9% vs 69.4%; P = .189) and positive margins (3.2% vs 3.1%; P = .955), were similar between the two groups. Although Black veterans were less likely to experience major postoperative complications, there was no difference in 30-day readmission, 30-day mortality, or disease-free survival between the two groups. Black patients had significantly better risk-adjusted overall survival (hazard ratio, 0.802; 95% CI, 0.729-0.883; P < .001). INTERPRETATION Among veterans with NSCLC undergoing surgical treatment through the VHA, Black patients received comparable care with equivalent if not superior outcomes compared with White patients.
Collapse
Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
| | | | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Martin W Schoen
- VA St. Louis Health Care System, St. Louis, MO; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
| |
Collapse
|
25
|
Wyatt TR. "The sins of our forefathers": reimagining research in health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1195-1206. [PMID: 35380319 DOI: 10.1007/s10459-022-10111-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/19/2022] [Indexed: 06/14/2023]
Abstract
As HPE begins to turn their attention to the lived experiences of minoritized groups in society, health professions education (HPE) researchers need to be aware of the history of social science research and the ways it contributes to creating systems of oppression. This is because as 'knowledge producers,' we make decisions about how to design our studies, analyze and interpret data, and report it in ways that are frequently oblivious to the harmful legacy of social science research, and how it continues to bring harm to minoritized communities. To not do so is to perpetuate a system that has historically served the dominant group at the expense of those who are limited in representing the world for themselves. This article proposes that HPE researchers engage in disruptive research practices by delinking with their disciplinary training, and reimagine their role in the research process. To accomplish this, I suggest that they engage in three strategies: attend to the research team's composition, embrace critical theory and investigate epistemological ignorance. These strategies are nowhere close to exhaustive, and they do not extend as far as the conversation must go in reimagining our role in the research enterprise. However, in providing some initial thoughts on this topic, I hope to invite the HPE community into discussion on how we might harness our collective responsibility to resist research practices that are harmful and unjust to minoritized communities.
Collapse
Affiliation(s)
- Tasha R Wyatt
- Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA.
| |
Collapse
|
26
|
The Case Against Race-Based GFR. Dela J Public Health 2022. [DOI: 10.32481/djph.2022.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
27
|
Robbins NM, Charleston L, Saadi A, Thayer Z, Codrington WU, Landry A, Bernat JL, Hamilton R. Black Patients Matter in Neurology: Race, Racism, and Race-Based Neurodisparities. Neurology 2022; 99:106-114. [PMID: 35851551 DOI: 10.1212/wnl.0000000000200830] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
Black people living in the United States suffer disproportionate morbidity and mortality across a wide range of neurologic conditions. Despite common conceptions to the contrary, "race" is a socially defined construct with little genetic validity. Therefore, racial health inequities in neurology ("neurodisparities") are not a consequence of biologic differences between races. Instead, racism and associated social determinants of health are the root of neurodisparities. To date, many neurologists have neglected racism as a root cause of neurologic disease, further perpetuating the problem. Structural racism, largely ignored in current neurologic practice and policy, drives neurodisparities through mediators such as excessive poverty, inferior health insurance, and poorer access to neurologic and preventative care. Interpersonal racism (implicit or explicit) and associated discriminatory practices in neurologic research, workforce advancement, and medical education also exacerbate neurodisparities. Neurologists cannot fulfill their professional and ethical responsibility to care for Black patients without understanding how racism, not biologic race, drives neurodisparities. In our review of race, racism, and race-based disparities in neurology, we highlight the current literature on neurodisparities across a wide range of neurologic conditions and focus on racism as the root cause. We discuss why all neurologists are ethically and professionally obligated to actively promote measures to counteract racism. We conclude with a call for actions that should be implemented by individual neurologists and professional neurologic organizations to mitigate racism and work towards health equity in neurology.
Collapse
Affiliation(s)
- Nathaniel M Robbins
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA.
| | - Larry Charleston
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Altaf Saadi
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Zaneta Thayer
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Wilfred U Codrington
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Alden Landry
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - James L Bernat
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Roy Hamilton
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
28
|
Wright JL, Davis WS, Joseph MM, Ellison AM, Heard-Garris NJ, Johnson TL. Eliminating Race-Based Medicine. Pediatrics 2022; 150:186963. [PMID: 35491483 DOI: 10.1542/peds.2022-057998] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Joseph L Wright
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
| | - Wendy S Davis
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
| | - Madeline M Joseph
- Departments of Emergency Medicine and Pediatrics, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Angela M Ellison
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nia J Heard-Garris
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tiffani L Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | | |
Collapse
|
29
|
Mahoney West H, Milliren CE, Manne-Goehler J, Davis J, Gallegos J, Perez JH, Köhler JR. Effect of clinician information sessions on diagnostic testing for Chagas disease. PLoS Negl Trop Dis 2022; 16:e0010524. [PMID: 35709253 PMCID: PMC9242495 DOI: 10.1371/journal.pntd.0010524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/29/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened. Methodology/Principal findings We conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11). Conclusion/Significance In this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition. Chagas disease is a potentially fatal neglected disease of poverty. It is endemic in continental Latin America with an estimated 300,000 cases in the United States, primarily among low-income people who have immigrated to the US from Latin America. Few Chagas screening programs have been established in the US. Existing recommendations for Chagas disease testing and treatment are rarely followed for many reasons including a paucity of knowledge among providers. We aimed to determine if the number of Chagas tests performed increased after information sessions at a community health center. A secondary aim was to determine if there was a difference in number of tests performed by provider type. We found that the number of T. cruzi serologies performed in the ten months after information sessions increased significantly over that in the ten preceding months. Chagas testing increased across departments, though Chagas diagnostics were an extra and unmitigated time burden on clinicians. Increasing provider knowledge is a major step to increase diagnosis and treatment of this neglected disease, when clinicians are motivated by their inherent prosocial preferences including altruism i.e., by the positive impact of their work on patients’ lives.
Collapse
Affiliation(s)
- Helen Mahoney West
- Division of Infectious Disease Boston Children’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Jillian Davis
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Jaime Gallegos
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Juan Huanuco Perez
- East Boston Neighborhood Health Center, Boston, Massachusetts, United States of America
| | - Julia R. Köhler
- Division of Infectious Disease Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
30
|
Hood AM, Booker SQ, Morais CA, Goodin BR, Letzen JE, Campbell LC, Merriwether EN, Aroke EN, Campbell CM, Mathur VA, Janevic MR. Confronting Racism in All Forms of Pain Research: A Shared Commitment for Engagement, Diversity, and Dissemination. THE JOURNAL OF PAIN 2022; 23:913-928. [PMID: 35288029 PMCID: PMC9415432 DOI: 10.1016/j.jpain.2022.01.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 01/25/2023]
Abstract
This third paper in the "Confronting Racism in All Forms of Pain Research" series discusses adopting an antiracism framework across all pain research disciplines and highlights the significant benefits of doing so. We build upon the previous call to action and the proposed reframing of study designs articulated in the other papers in the series and seek to confront and eradicate racism through a shared commitment to change current research practices. Specifically, we emphasize the systematic disadvantage created by racialization (ie, the Eurocentric social and political process of ascribing racialized identities to a relationship, social practice, or group) and discuss how engaging communities in partnership can increase the participation of racialized groups in research studies and enrich the knowledge gained. Alongside this critical work, we indicate why diversifying the research environment (ie, research teams, labs, departments, and culture) enriches our scientific discovery and promotes recruitment and retention of participants from racialized groups. Finally, we recommend changes in reporting and dissemination practices so that we do not stigmatize or reproduce oppressive forms of power for racialized groups. Although this shift may be challenging in some cases, the increase in equity, generalizability, and credibility of the data produced will expand our knowledge and reflect the pain experiences of all communities more accurately. PERSPECTIVE: In this third paper in our series, we advocate for a shared commitment toward an antiracism framework in pain research. We identify community partnerships, diversification of research environments, and changes to our dissemination practices as areas where oppressive forms of power can be reduced.
Collapse
Affiliation(s)
- Anna M Hood
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
| | - Staja Q Booker
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Calia A Morais
- Department of Community Dentistry and Behavioral Sciences, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Burel R Goodin
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa C Campbell
- Department of Psychology, East Carolina University, Greenville, North Carolina
| | - Ericka N Merriwether
- Department of Physical Therapy, Steinhardt School of Culture, Education, and Human Development, New York, New York; Department of Medicine, NYU Grossman School of Medicine, New York University, New York, New York
| | - Edwin N Aroke
- School of Nursing, Nurse Anesthesia Program, Department of Acute, Chronic, and Continuing Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas; Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas
| | - Mary R Janevic
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| |
Collapse
|
31
|
Lines LM, Humphrey JL, Barch DH. Imputing Race and Ethnicity: A Fresh Voices Commentary From The Medical Care Blog. Med Care 2022; 60:351-356. [PMID: 35319520 DOI: 10.1097/mlr.0000000000001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lisa M Lines
- RTI International, Research Triangle Park, NC
- University of Massachusetts Chan Medical School, Worcester, MA
| | - Jamie L Humphrey
- RTI International, Research Triangle Park, NC
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Daniel H Barch
- RTI International, Research Triangle Park, NC
- Psychology Department, Tufts University, Medford, MA
| |
Collapse
|
32
|
Aguwa UT, Wang J, Woreta F, Pettey J, Sun G, Pineles S, Srikumaran D. Residency Program Diversity Recruitment and Education: Survey of Efforts and Barriers to Implementation. JOURNAL OF SURGICAL EDUCATION 2022; 79:595-605. [PMID: 34952819 PMCID: PMC9064934 DOI: 10.1016/j.jsurg.2021.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/01/2021] [Accepted: 11/27/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Examine underrepresented minority (URM) recruitment and diversity education initiatives provided by residency programs in ophthalmology and other specialties, and identify means to support programs as they work to enhance diversity efforts. DESIGN Cross-sectional study. SETTING Multi-center survey of residency program leadership of the Association of University Professors of Ophthalmology, Johns Hopkins Medicine, University of Utah, and the University of California, Los Angeles. PARTICIPANTS Residency program leadership (i.e., residency program directors and associate residency program directors) RESULTS: Our survey response rate was 34% (63/188); 56% percent of responses were from ophthalmology and 44% were from other specialties. Across all specialties, programs with a large number of clinical faculty and trainees were associated with having ≥1 URM resident in their program (p = 0.026 and p = 0.028, respectively). There was no significant difference between ophthalmology and other specialties with regard to the number of URM residents. Ninety-two percent of programs utilized strategies to recruit URM applicants. While certain strategies were more common for ophthalmology than other specialties, information sessions for URM students (62%) and a unique review of all URM residency applicants by a separate committee/person (46%) were most commonly used overall. Although 92% of residency program leadership believed it was highly important for health professionals to receive formal diversity training, only 54% of programs had a diversity education curriculum for both trainees and faculty, 11% had a curriculum for faculty only, and 3% had a curriculum for trainees only. Barriers to implementation of curricula included lack of faculty expertise (30%) and curricular time (30%). CONCLUSIONS An overwhelming majority of programs in our study utilized strategies to recruit URM applicants, but 22% had 0 URM residents in their program. To address the reported barriers to diversity education implementation, shared central resources/diversity education toolkits should be created to provide programs with needed support.
Collapse
Affiliation(s)
- Ugochi T Aguwa
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeff Pettey
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Grace Sun
- Department of Ophthalmology, Weill Cornell Medicine, New York, New York
| | - Stacy Pineles
- Jules Stein Eye Institute, University of California, Los Angeles, California
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
33
|
Russell C. Meeting the Moment: Bioethics in the Time of Black Lives Matter. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:9-21. [PMID: 34854793 DOI: 10.1080/15265161.2021.2001093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this article, I begin by describing what I call this Black Lives Matter moment in the US. I then offer three reasons for considering racism as a bioethical issue, the least discussed of which is the way in which racism acts as a barrier to the creation of better healthcare systems. Next, I argue that the concept of race itself constitutes a bioethical issue in a way that is not fully reducible to racism. Finally, I discuss how we, both bioethicists and health care professionals, might meet this moment by identifying individual points of responsibility (beyond liability) for structural injustice.
Collapse
|
34
|
Latimore AD, Newman J, Beletsky L. Build It Better for Public Health: Improved Data Infrastructure Is Vital to Bending the Curve of the Overdose Crisis. Am J Public Health 2022; 112:S39-S41. [PMID: 35143278 PMCID: PMC8842215 DOI: 10.2105/ajph.2021.306697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Amanda D Latimore
- Amanda D. Latimore is with the American Institutes for Research Center for Addiction Research and Effective Solutions and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Justine Newman is with Health in Justice Action Lab, Northeastern University, Boston, MA. Leo Beletsky is with the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, and is with the Division of Infectious Disease and Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | - Justine Newman
- Amanda D. Latimore is with the American Institutes for Research Center for Addiction Research and Effective Solutions and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Justine Newman is with Health in Justice Action Lab, Northeastern University, Boston, MA. Leo Beletsky is with the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, and is with the Division of Infectious Disease and Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| | - Leo Beletsky
- Amanda D. Latimore is with the American Institutes for Research Center for Addiction Research and Effective Solutions and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Justine Newman is with Health in Justice Action Lab, Northeastern University, Boston, MA. Leo Beletsky is with the School of Law, Bouvé College of Health Sciences, and Health in Justice Action Lab, Northeastern University, and is with the Division of Infectious Disease and Global Public Health, University of California, San Diego School of Medicine, La Jolla, CA
| |
Collapse
|
35
|
Gardner NJ. Treating hypertension in Black patients. JAAPA 2022; 35:15-18. [PMID: 35076435 DOI: 10.1097/01.jaa.0000791512.37549.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT For the first time in its history, the Eighth Joint National Committee (JNC-8) published hypertension guidelines that varied depending on patient race, with different treatment recommendation for Black and non-Black patients. Although initial therapy in non-Black patients is to be carried out with one of four agents-thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers (ARBs)-the recommendation for Black patients removed ACE inhibitors and ARBs from the algorithm. This article reviews some of the physiologic theories for the difference in recommendations and discusses potential complications with race-based treatment algorithms.
Collapse
Affiliation(s)
- Nathan J Gardner
- Nathan J. Gardner is program director and an assistant professor in the PA program at Albany (N.Y.) Medical College. The author has disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|
36
|
Badiee RK, Yang SC, Alcon A, Weeks AC, Rosenbluth G, Pomerantz JH. Disparities in Timing of Alveolar Bone Grafting and Dental Reconstruction in Patients With Clefts. Cleft Palate Craniofac J 2022; 60:639-644. [PMID: 35044260 DOI: 10.1177/10556656211073049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study sought to identify disparities in the timing of alveolar bone grafting (ABG) surgery and the replacement strategy for missing maxillary lateral incisors for patients with clefts. A retrospective record review identified patients who underwent ABG. Multivariable regression analyzed the independent contribution of each variable. This institutional study was performed at the University of California, San Francisco. Patients who presented under age 12 and underwent secondary ABG between 2012 and 2020 (n = 160). The age at secondary ABG and the recommended dental replacement treatment for each patient, either dental implantation or canine substitution. The average age at ABG was 10.8 ± 2.1 years, 106 (66.3%) patients were not White, and 80 (50.0%) had private insurance. Independent predictors of older age at ABG included an income below $ 50 000 as estimated from ZIP code (β = 15.0 months, 95% CI, 5.7-24.3, P = .002) and identifying as a race other than White (β = 10.1 months, 95% CI, 2.1-18.0, P = .01). After ABG, patients were more likely to undergo dental implantation over canine substitution if they were female (odds ratio [OR] = 4.3, 95% CI, 1.3-17.1, P = .02) or had private insurance (OR = 12.5, 95% CI, 2.2-143.2, P = .01). Patients who were low-income or not White experienced delays in ABG, whereas dental implantation was more likely to be recommended for patients with private insurance. Understanding the sources of disparities in dental reconstruction of cleft deformities may reveal opportunities to improve equity.
Collapse
Affiliation(s)
- Ryan K Badiee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UCSF Craniofacial Center, 8785University of California San Francisco, San Francisco, CA, USA
| | - Stephen C Yang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, 8785University of California San Francisco, San Francisco, CA, USA
| | - Andre Alcon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UCSF Craniofacial Center, 8785University of California San Francisco, San Francisco, CA, USA
| | - Andrew C Weeks
- Department of Oral and Maxillofacial Surgery, School of Dentistry, 8785University of California San Francisco, San Francisco, CA, USA
| | - Glenn Rosenbluth
- Division of Pediatric Hospital Medicine, Department of Pediatrics, 8785University of California San Francisco, San Francisco, CA, USA.,Division of Orofacial Sciences, School of Dentistry, 8785University of California San Francisco, San Francisco, CA, USA
| | - Jason H Pomerantz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UCSF Craniofacial Center, 8785University of California San Francisco, San Francisco, CA, USA.,Division of Orofacial Sciences, School of Dentistry, 8785University of California San Francisco, San Francisco, CA, USA.,Program in Craniofacial Biology, 8785University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
37
|
The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort. Int J Nephrol 2021; 2021:1880499. [PMID: 34824870 PMCID: PMC8610663 DOI: 10.1155/2021/1880499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/02/2021] [Accepted: 10/28/2021] [Indexed: 01/13/2023] Open
Abstract
The widely used Modification of Diet in Renal Disease (MDRD) formula adapts a 1.212 multiplier for individuals who are identified as African Americans (AAs) or Blacks, which leads to a higher GFR estimation. As it stands, AAs have a lower prevalence of chronic kidney disease (CKD) but higher incidence of end-stage renal disease (ESRD) compared with Whites. Many hypotheses have been postulated to explain this paradox, but the imprecision of the GFR estimation with race-adaptation could be contributory. We performed a single-center, longitudinal, retrospective study on a cohort of outpatient AA patients using the MDRD and MDRDrace removed and CKD-EPI and CKD-EPIrace removed and their progression to CKD G5 (eGFR <15 ml/min/1.73 m2). 327 patients were analyzed. Median follow-up was 88.1 months (interquartile range, 34.4–129.1). When race was removed from MDRD, 39.9% of patients in CKD G1/2 were reclassified to CKD G3a, 72.6% of patients in CKD G3a would be reclassified to CKD G3b, and 54.1% and 36.4% of patients would be reclassified from CKD 3b to CKD G4 and CKD G4 to CKD G5, respectively (p < 0.0001). Comparing the CKD-EPI formula against the MDRD in our cohort, we found that 8.2%, 18.8%, and 11.4% of patients were reclassified from CKD G1/2 to CKD G3a, CKD G3a to G3b, and CKD G3b to CKD G4 respectively. Overall median time to progression to CKD G5 was 137.4 (131.9–142.8) months in patients who were not reclassified and 133.6 (127.6–139.6) months for patients who were reclassified by MDRDrace removed(p < 0.288). Concerns of inequitable access to healthcare have elicited calls to review race-corrected eGFR equations. A substantial number of individuals would have their CKD stage reclassified should have the MDRDrace removed equation be adopted en masse on an AA-only population. The discrepancy is highest at the 45–59 and >60 ml/min/1.72 min2 ranges. This will have tremendous impact on our center's approach to pharmacological dosing, referral system, best practices, and outcome surveillance. Comprehensive review of the current “race-corrected” eGFR will require a multifaceted approach and adjunctive use of noncreatinine-based approach.
Collapse
|
38
|
Horwitz RI, Lobitz G, Mawn M, Conroy AH, Cullen MR, Sim I, Singer BH. Rethinking Table 1. J Clin Epidemiol 2021; 142:242-245. [PMID: 34800675 DOI: 10.1016/j.jclinepi.2021.11.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022]
Abstract
Clinical and translational medicine studies of disease risk or treatment response typically include a table 1 comparing groups on age, sex, and race and/or ethnicity. Although customarily treated as biological variables, each denote biography, elements of a person's lived experience. Capturing these biographical features is essential to achieving the ambition of personalized medicine.
Collapse
Affiliation(s)
- Ralph I Horwitz
- Department of Medicine, Temple University Lewis Katz School of Medicine, Philadelphia, PA.
| | - Gabriella Lobitz
- Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | - McKayla Mawn
- Temple University Lewis Katz School of Medicine, Philadelphia, PA
| | | | - Mark R Cullen
- Stanford Center for Population Health Sciences, Palo Alto, CA
| | - Ida Sim
- Division of General Internal Medicine at University of California San Francisco, San Francisco, CA
| | | |
Collapse
|
39
|
Measuring the Effect of Place, Socioeconomic Status, and Racism on Coronary Heart Disease: Recent Trends and Missed Opportunities. CURR EPIDEMIOL REP 2021. [DOI: 10.1007/s40471-021-00281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
40
|
Kaufman JS, Merckx J, Cooper RS. Use of Racial and Ethnic Categories in Medical Testing and Diagnosis: Primum Non Nocere. Clin Chem 2021; 67:1456-1465. [PMID: 34557889 DOI: 10.1093/clinchem/hvab164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Use of race and ethnicity is common in medical tests and procedures, even though these categories are defined by sociological, historical, and political processes, and vary considerably in their definitions over time and place. Because all societies organize themselves around these constructs in some way, they are undeniable facets of the human experience, with myriad health consequences. In the biomedical literature, they are also commonly interpreted as representing biological heterogeneity that is relevant for health and disease. CONTENT We review the use of race and ethnicity in medical practice, especially in the USA, and provide 2 specific examples to represent a large number of similar instances. We then critique these uses along a number of different dimensions, including limitations in measurement, within- versus between-group variance, and implications for informativeness of risk markers for individuals, generalization from arbitrary or nonrepresentative samples, perpetuation of myths and stereotypes, instability in time and place, crowding out of more relevant risk markers, stigmatization, and the tainting of medicine with the history of oppression. We conclude with recommendations to improve practice that are technical, ethical, and pragmatic. SUMMARY Medicine has evolved from a mystical healing art to a mature science of human health through a rigorous process of quantification, experimentation, and evaluation. Folkloric traditions, such as race- and ethnic-specific medicine will fade from use as we become increasingly critical of outdated and irrational clinical practices and replace these with personalized, evidenced-based tests, algorithms, and procedures that privilege patients' individual humanity over obsolete and misleading labels.
Collapse
|
41
|
Morse BL, Carmichael AE, Bradford VA, Pollard AL. Sickle Cell Disease Care Planning for School Nurses. NASN Sch Nurse 2021; 37:48-54. [PMID: 34292091 DOI: 10.1177/1942602x211025079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schoolchildren with sickle cell disease (SCD) experience physiologic and psychologic stress that can affect school functioning, mental well-being, and physical health. Student needs are unique and individualized; however, school nurses can support students and families with SCD through comprehensive and thorough care planning efforts. In addition to components specific to individual prescriptions and other nonpharmacological therapies, school nurses should consider school access and inclusion, pain management, racism, and disease self-management when care planning. As a healthcare provider who may have several continuous years of near-daily contact with students, the school nurse is an imperative provider, educator, and advocate for students learning to manage their SCD and avoid the related complications and challenges.
Collapse
|
42
|
Soled DR, Chatterjee A, Olveczky D, Lindo EG. The Case for Health Reparations. Front Public Health 2021; 9:664783. [PMID: 34336763 PMCID: PMC8323065 DOI: 10.3389/fpubh.2021.664783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
The disproportionate impact of COVID-19 on racially marginalized communities has again raised the issue of what justice in healthcare looks like. Indeed, it is impossible to analyze the meaning of the word justice in the medical context without first discussing the central role of racism in the American scientific and healthcare systems. In summary, we argue that physicians and scientists were the architects and imagination of the racial taxonomy and oppressive machinations upon which this country was founded. This oppressive racial taxonomy reinforced and outlined the myth of biological superiority, which laid the foundation for the political, economic, and systemic power of Whiteness. Therefore, in order to achieve universal racial justice, the nation must first address science and medicine's historical role in scaffolding the structure of racism we bear witness of today. To achieve this objective, one of the first steps, we believe, is for there to be health reparations. More specifically, health reparations should be a central part of establishing racial justice in the United States and not relegated to a secondary status. While other scholars have focused on ways to alleviate healthcare inequities, few have addressed the need for health reparations and the forms they might take. This piece offers the ethical grounds for health reparations and various justice-focused solutions.
Collapse
Affiliation(s)
- Derek Ross Soled
- Harvard Medical School, Boston, MA, United States
- Harvard Business School, Boston, MA, United States
| | - Avik Chatterjee
- School of Medicine, Boston University, Boston, MA, United States
- Boston Medical Center, Boston, MD, United States
| | - Daniele Olveczky
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Edwin G. Lindo
- School of Medicine, University of Washington, Seattle, WA, United States
| |
Collapse
|
43
|
"First do no harm": Clinical practice guidelines, mesolevel structural racism, and medicine's epistemological reckoning. Soc Sci Med 2021; 279:113968. [PMID: 34022676 DOI: 10.1016/j.socscimed.2021.113968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/18/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
This paper presents a critique of clinical practice guidelines (CPGs) that standardize the use of race as a proxy for biological difference in medical settings. Drawing on the illustrative example of a pediatric UTI testing guideline, we contend that when CPGs necessitate that Black patients meet a higher threshold of illness severity or duration than their non-Black counterparts to receive comparable medical testing or other medical care, they function as mesolevel sites of race-racism reification processes (see Sewell, 2016) that contribute to the reproduction of racial health disparities. We describe broader implications and make recommendations for the conceptualization and implementation of future research in the sociological study of race, health, and medicine.
Collapse
|
44
|
Dineen KK, Pendo E. Ending the War on People with Substance Use Disorders in Health Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:20-22. [PMID: 33825650 DOI: 10.1080/15265161.2021.1891353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
45
|
Yearby R. Reifying Racism in the COVID-19 Pandemic Response. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:75-78. [PMID: 33616504 DOI: 10.1080/15265161.2020.1870773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Ruqaiijah Yearby
- Saint Louis University School of Law
- The Institute for Healing Justice and Equity, Saint Louis University
| |
Collapse
|
46
|
Danis M. Putting Anti-Racism into Practice as a Healthcare Ethics Consultant. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:36-38. [PMID: 33534690 PMCID: PMC7931635 DOI: 10.1080/15265161.2020.1861387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
|
47
|
King NMP, Henderson GE, Churchill LR. Beyond the Medical Model: Retooling Bioethics for the Work Ahead. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:53-55. [PMID: 33534685 DOI: 10.1080/15265161.2020.1861382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
48
|
|
49
|
Cerdeña JP. Race-Conscious Bioethics: The Call to Reject Contemporary Scientific Racism. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:48-53. [PMID: 33534686 DOI: 10.1080/15265161.2020.1861383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
50
|
James JE, Iacopetti CL. Beyond Seeing Race: Centering Racism and Acknowledging Agency Within Bioethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:56-58. [PMID: 33534684 DOI: 10.1080/15265161.2020.1861380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|